OBJECTIVE: The objective of this study was to determine the incidence and risk factors for AEs (all-cause and individual types) associated with umbilical venous catheters (UVCs) and umbilical arterial catheters (UACs) in the NICU.
METHODS: A retrospective cohort study was conducted in an Australian level-VI NICU over a 3-year period. Any newborn who had both a UVC and UAC insertion attempt was included.
RESULTS: There were 236 neonates who had 494 catheters (245 UVCs and 249 UACs). Of these, 71% of UVCs (95% confidence interval [CI]: 65.6-76.9%; incidence rate: 181.1-237.3 per 1000 catheter days) and 43.8% of UACs (95% CI: 38-50.5%; incidence rate: 102.0-146.3 per 1000 catheter days) were associated with an AE. The most common AE was malposition on first X-ray for UVCs (60.1%, 95% CI: 55.1-67.3) and UACs (32.6%, 95% CI: 26.8-39.6). A dwell time of ≥7 days was a significant predictor of UAC failure (incidence risk ratio: 1.5, 95% CI: 1.1-2.1, p = 0.006) and migration of the UVC (incidence risk ratio: 3.5, 95% CI: 1.0-11.5, p = 0.043).
CONCLUSIONS: Adverse events related to insertion occurred in a relatively high percentage of umbilical catheters placed. Increased dwell time remains a significant risk factor for catheter migration and overall failure. Practice change and consideration of risk factors for both individual and overall AE risk are necessary to reduce complications.
目的:本研究的目的是确定NICU中与脐静脉导管(UVC)和脐动脉导管(UAC)相关的AE(全因和个体类型)的发生率和危险因素。
方法:在澳大利亚VI级NICU进行了一项为期3年的回顾性队列研究。包括任何同时有UVC和UAC插入尝试的新生儿。
结果:有236例新生儿有494个导管(245个UVC和249个UAC)。其中,71%的UVC(95%置信区间[CI]:65.6-76.9%;发生率:181.1-237.3/1000导管天)和43.8%的UAC(95%CI:38-50.5%;发生率:102.0-146.3/1000导管天)与AE相关。最常见的AE是UVC的首次X射线错位(60.1%,95%CI:55.1-67.3)和UAC(32.6%,95%CI:26.8-39.6)。≥7天的停留时间是UAC失败(发生率风险比:1.5,95%CI:1.1-2.1,p=0.006)和UVC迁移(发生率风险比:3.5,95%CI:1.0-11.5,p=0.043)的重要预测指标。
结论:与插入相关的不良事件发生在相对较高百分比的脐带导管中。增加的停留时间仍然是导管迁移和整体失效的重要风险因素。改变实践并考虑个体和总体AE风险的危险因素对于减少并发症是必要的。